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Clinical predictors of adverse outcome in severe sepsis patients with lactate 2 to 4 mM admitted to the hospital.
QJM. 2014 Sep 4;
Authors: Tang Y, Choi J, Kim D, Tudtud-Hans L, Li J, Michel A, Baek H, Hurlow A, Wang C, Nguyen HB
Abstract
BACKGROUND: Severe sepsis patients with initial lactate level 2 to 4 mM are commonly considered to have lower risk for mortality and adverse outcomes.
AIM: We aim to determine clinical variables that are associated with adverse outcome in these patients.
DESIGN: A retrospective cohort study.
METHODS: Severe sepsis patients with initial lactate ≥ 2 and < 4 mM admitted to our hospital were examined for any of the following primary outcomes: 1) in-hospital death, 2) vasopressor requirement, 3) use of mechanical ventilator, 4) lactate ≥ 4.0 mM, or 5) need care in the intensive care unit (ICU) within 48 hours.
RESULTS: Five-hundred and thirty-five patients were enrolled, age 58.7±19.3 years, 53.2% male. The most common sources of infection were urinary tract infection and pneumonia, 38.3 and 35.7%, respectively. One-hundred and twenty four (23.2%) patients had at least one primary adverse outcome within 48 hours, including in-hospital death 1.1%, vasopressor requirement 12.9%, use of mechanical ventilator 13.3%, increase lactate ≥ 4.0 mM in 5.6% patients, and 21.5% of patients requiring ICU (including 13.8% of the patients admitted directly to ICU from the emergency department, and 7.7% initially admitted to the general medical ward but later required ICU transfer). Altered mentation, hypotension, tachypnea, and elevated blood urea nitrogen at admission were associated with the primary outcome in multivariable logistic regression analysis, odds ratio 2.50 (95% confidence interval 1.54, 4.06), 3.76 (2.31, 6.10), 1.97 (1.22, 3.17), and 1.78 (1.11, 2.83), respectively.
PMID: 25193540 [PubMed - as supplied by publisher]